Osteoarthritis

Osteoarthritis, commonly referred to as degenerative joint disease, is the most common joint disorder. It's a chronic condition causing the deterioration of joint cartilage and the formation of reactive new bone at the margins and subchondral areas of the joints. It usually affects weight bearing joints (knees, feet, hips,lumbar vertebrae). Osteoarthritis is widespread (affecting more than 60 million persons in the United States) and is most common in women. tYpically, its earliest symptoms manifest in middle age and progress from there.

Disability depends on the site and severity of involvement and can range from minor limitation of finger movement to severe disability in persons with hip or knee involvement. The rate of progression varies, and joints may remain stable for years in an early stage of deterioration.

What causes Osteoarthritis?

Osteoarthritis occurs in synovial joints. The primary defect in both idiopathic and secondary osteoarthritis is loss of articular cartilage due to functional changes in chondrocytes (cells responsible for the formation of the proteoglycans, glycoproteins that act as cementing material in the cartilage, and collagen). New bone, called osteophyte (bone spur), then forms at joint margins as the articular cartilage erodes, causing gross alteration of the bony contours and enlargement of the joint.

Idiopathic osteoarthritis, a normal part of aging, results from many factors, including:

• metabolic factors (endocrine disorders such as hyperparathyroidism) and genetic factors (decreased collagen synthesis)
• chemical factors (drugs that stimulate the collagen-digesting enzymes in the synovial membrane such as steroids)
• mechanical factors (repeated stress on the joint).

Secondary osteoarthritis usually follows an identifiable predisposing event that leads to degenerative changes. such as:

• trauma (most common cause)
• congenital deformity
• hormonal changes (particularly low estrogen levels)
• obesity.

Signs and symptoms of Osteoarthritis

Symptoms, which increase with poor posture, obesity, and occupational stress, include:

• deep, aching joint pain due to degradation of the cartilage, inflammation, and bone stress, particularly after exercise or weight bearing (the most common symptom, usually relieved by rest)
• stiffness in the morning and after exercise (relieved by rest)
• crepitus, or "grating" of the joint during motion due to cartilage damage
• Heberden's nodes (bony enlargements of the distal interphalangeal joints) due to repeated inflammation
• altered gait from contractures due to overcompensation of the muscles supporting the joint
• decreased range of motion (ROM) due to pain and stiffness
• joint enlargement due to stress on the bone and disordered bone growth . localized headaches (may be a direct result of cervical spine arthritis).

Complications of osteoarthritis include:

• irreversible joint changes and node formation (with nodes eventually becoming red, swollen, and tender, causing numbness and loss of finger dexterity)
• subluxation of the joint
• decreased joint ROM
• joint contractures
• pain (can be debilitating in later stages)
• loss of independence in activities of daily living.

Diagnosis information

Findings that help diagnose osteoarthritis include:

• absence of systemic symptoms (ruling out inflammatory joint disorder)
• arthroscopy showing bone spurs and narrowing of joint space
• increased erythrocyte sedimentation rate (with extensive synovitis).

X-rays of the affected joint help confirm the diagnosis but may be normal in the early stages. X-rays may require many views and typically show:

• narrowing of joint space or margin
• cyst like bony deposits in joint space and margins as well as sclerosis of the subchondral space
• joint deformity due to degeneration or articular damage
• bony growths at weight-bearing areas
• joint fusion.

Treatment of Osteoarthritis

The goal of treatment is to relieve pain. maintain or improve mobility, and minimize disability. Treatment may include:

• weight loss to reduce stress on the joint
• balance of rest and exercise, such as swimming
• medications, including aspirin, fenoprofen (Nalfon), ibuprofen (Motrin). indomethadn (Indodn), phenylbutazone, and other nonsteroidal anti-inflammatory drugs; propoxyphene (Darvon); COX-2 inhibitors, such as celecoxib (Celebrex); and analgesic creams such as capsaidn (Capsin).
• support or stabilization of joint with crutches, braces, cane, walker, cervical collar, or traction to reduce stress
• intra-articular injections of corticosteroids (every 4 to 6 months) to possibly delay node development in the hands (if used too frequently. may accelerate arthritic progression by depleting the normal ground substance of the cartilage).

Surgical treatment, reserved for patients with severe disability or uncontrollable pain, may include:

• arthroplasty (partial or total replacement of the deteriorated part of the joint with a prosthetic appliance)
• arthrodesis (surgical fusion of bones, primarily in the spine [laminectomy))
• osteoplasty (scraping and lavage of deteriorated bone from the joint)
• osteotomy (change in alignment of bone to relieve stress by excision of a wedge of bone or cutting of the bone).

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Risks for Developing Osteoarthritis?

• Excessive Weight
• If you were born 'double jointed' you are vulnerable to Osteoarthritis.
• Scoliosis (curvature of the spine) puts you at risk.
• Athletes who use anabolic steroid.

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Special considerations and Prevention

• Promote adequate rest, particularly after activity. Plan rest periods during the day. and provide for adequate sleep at night. Moderation is the key - teach the patient to pace daily activities.
• Assist with physical therapy, and encourage the patient to perform gentle, isometric ROM exercises.
• If the patient needs surgery. provide appropriate preoperative and postoperative care.
• Provide emotional support and reassurance to help the patient cope with limited mobility. Explain that osteoarthritis isn't a systemic disease.